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CLASSIFICATION AND
MECHANISMS OF INJURIES
OBJECTIVES

MECHANISMS OF INJURY
 TISSUE-BASED CLASSIFICATION
 GENERAL PATHOLOGY OF THE
REPAIR PROCESS
 BASIC BIOMECHANICS OF TISSUE
INJURY
OBJECTIVES

LIGAMENTS AND TENDONS
 BONE
 FIBROCARTILAGE MENISCI OF THE
KNEE
 MUSCLE
MECHANISMS OF INJURY

PRIMARY INJURY:
 1) DIRECT OR EXTRINSIC INJURY
 2) INDIRECT OR INTRINSIC INJURY
 3) OVERUSE INJURY:
 A) ACUTE REPETITIVE FRICTION
 B) CHRONIC REPETITIVE
MICROFATIGUE
MECHANISMS OF INJURY

SECONDARY INJURY:
 1) SHORT TERM – PRIMARY INJURY
MISMANAGED
 2) LONG TERM – DEGENERATIVE
PROBLEMS ( ACL )
TISSUE-BASED
CLASSIFICATION

SOFT TISSUE INJURIES:
 1) SKIN AND DEEP FASCIA
 2) MUSCLE-TENDON UNIT AND
TENDOPERIOSTEAL ATTACHMENTS
 3) MUSCLE COMPARTMENTS
 4) JOINTS AND THEIR ASSOCIATED
STRUCTURES
 5) INTEVERTEBRAL DISC
TISSUE BASED
CLASSIFICATION

HARD TISSUE INJURIES:
 1) BONE FRACTURES,
OSTEOCHONDRAL FRACTURES AND
AVULSIONS
 2) PERIOSTITIS
 3) STRESS FRACTURES
 4) HYALINE ARTICULAR AND
EPIPHYSEAL CARTILAGE INJURIES
TISSUE BASED
CLASSIFICATIONS

SPECIAL TISSUE OR ORGAN
INJURIES:
 1) BRAIN AND PERIPHERAL NERVES
 2) EYE, NOSE, SINUSES, LARYNX,
TEETH
 3) THORACIC, ABDOMINAL AND
PELVIC ORGANS
GENERAL PATHOLOGY OF
THE REPAIR PROCESS

THREE PHASES: ( ALVAREZ ET AL 1987 )
 1) THE ACUTE INFLAMMATORY RESPONSE
( APPROX.0-72H AFTER INJURY )
 2) THE MATRIX AND CELLULAR
PROLIFERATION PHASE (72H-6/52 )
 3) REMODELING AND MATURATION OF
HEALING ( 6/52 – 7/12 )
BASIC BIOMECHANICS OF
TISSUE INJURY

MUSCLE-TENDON-BONE INJURY:
 1) “ TWO-JOINT MUSCLES” – RECTUS
FEMORIS AND HAMSTRINGS
 2) ECCENTRIC AND LESS
CONCENTRIC LOADING – JUMPERS
KNEE
BASIC BIOMECHANICS OF
TISSUE INJURY

MUSCLE-TENDON JUNCTION:
 - THE TERMINAL MUSCLE
SARCOMERE INFOLDING
 TENDON INJURY:
 SPONTANEOUS TENDON RUPTURE:
LIGAMENTS AND TENDONS

1) STRUCTURE AND BIOMECHANICS
OF LIGAMENTS AND TENDONS
 2) CORRELATION OF COLLAGEN
FIBRIL SIZE WITH MECHANICAL
PROPERTIES OF TISSUE
 3) THE EFFECTS OF IMMOBILIZATION
OF LIGAMENTS
BONE

1) ACUTE FRACTURES
 2) AVULSION FRACTURES
 3) STRESS FRACTURES: THRESHOLD
LEVEL VS CYCLIC LOADING
 MEASURE OF PLASMA
HYDROXYPROLINE (BONE
RESORPTION )
FIBROCARTILAGE MENISCI

LOCATION OF THE TEAR DICTATES
THE RESPONSE TO THE INJURY
MUSCLE

TWO COMPETING PROCESSES
DURING MUSCLE HEALING:
 1) REGENERATION OF THE
DISRUPTED MUSCLE FIBRES
 2) THE PRODUCTION OF
CONNECTIVE TISSUE COLLAGEN
MUSCLE

- IMMOBILIZATION ( LESS POSSIBLE )
WILL REDUCE CONNECTIVE TISSUE AND
ASSIST PENETRATION OF REGENERATED
FIBRES
 - STRETCHED MUSCLES WILL INCREASE
NUMBER OF TERMINAL SARCOMERES,
REDUCE INTRAMUSCULAR CONNECTIVE
TISSUE